Lawmakers at Impasse on ACA Stabilization

One dispute during omnibus negotiations involved the possible inclusion of a measure to stabilize the Affordable Care Act’s (ACA) individual health insurance market. Senate Health, Education, Labor, and Pensions (HELP) Committee Chairman Lamar Alexander (R-Tenn.), House Energy and Commerce Committee Chairman Greg Walden (R-Ore.), Sen. Susan Collins (R-Maine) and Rep. Ryan Costello (R-Pa.) strongly pushed for the inclusion of their proposal, which would allocate $30 billion over three years for the creation of high-risk pools. The plan would increase flexibility for states through reforms to the 1332 waiver process, pare back copper health plans, allow insurers to sell across state lines, expand access to some short-term insurance plans that don’t meet ACA coverage requirements, and fund three-years of cost sharing payments for those earning less than 250 percent of the federal poverty limit (FPL). The plan also included language applying the Hyde Amendment, which restricts federal money from being spent on abortion, to any funds aimed at lowering Obamacare premiums. Democrats argued that this would prevent the government from spending money on any insurance plan that offered coverage for abortion. Democrats also opposed the Administration’s short-term insurance expansion proposal, and sought to block it through the stabilization measure, not codify it. While President Trump reportedly expressed his support for funding health insurance subsidies within the omnibus, the House left the stabilization proposal out of their funding bill and HELP Committee Ranking Member Patty Murray (D-Wash.) blocked the amendment to the spending bill in the Senate. Although Murray said that she believes a compromise is still possible, Sens. Alexander and Collins expressed doubt that an agreement could be reached before insurers set their premium rates for 2019. Congressional action to stabilize the market is supported by a wide range of health care stakeholders, including America’s Health Insurance Plans (AHIP), the American Hospital Association (AHA), and the American Medical Association (AMA), who wrote to House and Senate leadership last week urging passage of the fix.

White House Unveils Strategy to Combat Opioid Epidemic

The White House released the President’s Initiative to Stop Opioid Abuse and Reduce Drug Supply and Demand last week. The Administration’s three-pronged approach aims to slow overprescribing, reduce the supply of illicit drugs, and increase access to evidence-based treatment for those suffering from addiction. Many of the policies contained in the plan stem from the recommendations of the President’s Opioid Commission released in November. The Administration’s goal is to reduce the number of opioid prescriptions by one-third nationwide over the next three years.

The White House proposal would tighten the number of prescriptions that can be reimbursed in the Medicaid program. It would also create and incentivize states to move to a national prescription drug monitoring system. The plan calls for increasing first responders’ supply of naloxone and expanding the use of medication assisted treatment (MAT). All federal inmates would be tested for opioid addiction and provided options for treatment upon completion of their sentences. The plan also includes new public outreach to deter drug use. The Administration expresses opposition to medically supervised drug consumption, noting the lack of evidence supporting the efficacy of such facilities.

The plan would also apply stiffer penalties for drug traffickers, including the death penalty, when appropriate under current law. The Administration calls on Congress to reduce the threshold for mandatory minimum sentencing on fentanyl dealers, and more aggressively police the Internet and mail for fentanyl purchases and shipments.

President Trump outlined the plan during a speech in New Hampshire last Monday. His remarks stressed the importance of tougher penalties for drug dealers and traffickers, eliminating sanctuary cities, and strengthening border protections to prevent drugs coming in from Mexico. During his remarks, the President called for increased funding for the development of non-addictive painkillers, and indicated that the Justice Department is considering federal litigation against opioid manufacturers. He also stated that drug companies would provide free narcan to schools. The President’s focus on punitive measures drew criticism from many public health stakeholders, who believe that underscoring a law enforcement approach overshadows the more important measures of the Administration’s plan that are widely supported by addiction advocates.

Although the President stated his intent to spend “the most money ever on the opioid crisis,” it remains unclear how the proposals contained in the White House’s strategy will be paid for. The Administration has stated that negotiations with Congress are underway on specific funding allocations.

There were a number of other opioid-related activities on Capitol Hill last week. The acting head of the Drug Enforcement Administration (DEA) testified about the agency’s role in combating the opioid epidemic and alleged pill-dumping in West Virginia before the House Energy and Commerce Oversight and Investigations Subcommittee on Tuesday, and the House Energy and Commerce Committee considered 25 opioid-related bills over the course of a two-day hearing. The Committee aims to bring a bipartisan legislative package to the House floor by Memorial Day.

Administration Teases Drug Pricing Plan

During his speech to unveil the White House’s strategy to combat the opioid crisis, President Trump also announced that he is planning a major news conference on the issue of prescription drug prices. The President blamed pharmaceutical companies and the drug distribution system for the rising cost of prescription medicines and criticized the high cost of treatments in the U.S. compared with prices for the same products in other countries. The Administration’s plan, expected to be released in about a month, aims to decrease the cost of drugs and reform pharmacy benefit manager (PBM) discounts to the advantage of individual patients. Secretary of the U.S. Department of Health and Human Services (HHS) Alex Azar noted that the Administration’s plan will also include a request for input from stakeholders, and stated that his goal is to bring down list prices and achieve the best net prices for government programs and private insurers.

In related news, Secretary Azar has reportedly hired Daniel Best, Vice President of CVS Caremark, to head the Department’s effort to lower drug prices. While an official announcement has not been made, Best was added to the HHS staff directory as Senior Advisor to the Secretary for Drug Pricing Reform. Best headed CVS’ Medicare Part D business, and previously worked as Director of Business Development for Pfizer.

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